Is bone lengthening over an intramedullary prosthesis stem possible and safe?

Here we report the case of a 13-year-old girl with a history of massive left knee arthroplasty after excision of a proximal tibial osteosarcoma with subsequent leg length inequality. Owing to her short stature and her parents' refusal of surgical shortening by epiphysiodesis of the right lower limb, tibial lengthening over the prosthesis stem using an Ilizarov apparatus was undertaken and achieved 5 cm good quality regenerate but with a secondary infection leading to prosthesis removal. To the best of the authors' knowledge, no similar case has been previously reported in the literature. Although the goal of bone lengthening was achieved, this procedure should be avoided because of the high risk of secondary infection.